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Full-Time Opportunity: This is a permanent, full-time position with a competitive package and real career growth potential.
Job Description
What you do
- Responsible for activities related to review and inspection to apply quality standards for operational claim processes and adjudication.
- Creates clear and accurate audit findings and recommendations in written audit processing status codes that provide feedback to examiners used in the examiner score card, identifies error trends and training opportunities.
- Understand, interpret, and apply coding and reimbursement guidelines, provider and Health Plan contracts for professional claims to ensure accuracy.
- Audit, assess, and monitor providers and payers, including physicians, inpatient, outpatient, ancillary, behavioral healthcare, laboratory, etc., and independently code and abstract medical records.
- Analyze inpatient and outpatient medical records using current ICD-9/ICD-10, CPT, HCPCS, UB, and other codes, regulatory and contractual requirements, and generally accepted coding practices.
- Verify and valid...